Depression during Pregnancy

Abstract

Depression during pregnancy is common, affecting an estimated 20% of women. However, conflicting data exist concerning the outcomes of this disorder. Thus, we reviewed studies that presented evidence for the use of antidepressants and those that examined untreated depression during the gestational period, in terms of clinical and epidemiological aspects.Observational studies have provided reassuring evidence of the safety of antidepressant use during pregnancy. However, due to the reluctance of healthcare providers to prescribe and patients to take medication during the obstetric period, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, healthcare providers apparently do not recognise the disorder in up to 50% of pregnant women who experience depression. Increased antidepressant dosing during pregnancy may be required to maintain euthymia; however, guidelines for effective dosing levels are absent. Consequently, many patients remain inadequately treated. Substantial maternal and fetal morbidity including substance abuse, functional impairment, increased risk of postnatal depression, and poor pregnancy outcomes have resulted from untreated depression.The consequences of those outcomes are likely to be associated with substantial clinical, social and economic burdens. An incidence-based assessment of the consequences of prenatal depression would be useful in order to: (i) establish the impact on the quality of life of these patients and their families; (ii) assess the associated economic burden on individual families and the healthcare system; and (iii) to provide epidemiological data to enable the provision of suitable management strategies for these patients.

The Impact of Antenatal Depression on Perinatal Outcomes in Australian Women

“…Even though in the current analysis, the prevalence of maternal depressive symptoms during pregnancy was not stratified by trimesters due to a lack of depression measures at visits subsequent to the first antenatal visit, previous studies have suggested that the prevalence of maternal depression during pregnancy can vary across trimesters [58, 65]. The highest prevalence of clinical depression has been reported in the first and third trimester of pregnancy [66, 67].…”

Using the Patient Health Questionnaire (PHQ-9) and the Edinburgh Postnatal Depression Scale (EPDS) to assess suicidal ideation among pregnant women in Lima, Peru

“…Given the paucity of research evaluating the comparability of two suicidal ideation items from the PHQ-9 and EPDS during pregnancy and a growing body of evidence documenting antepartum depression as one of the major causes of morbidity in low- and middle-income countries (Bennett et al 2004; Ferrari et al 2013), we conducted the present study to examine the concordance of the two suicidal ideation items among pregnant Peruvian women. Considering the lack of updated information among this population, the prevalence of suicidal ideation was assessed using the PHQ-9 and the EPDS.…”

A meta-analysis of treatments for perinatal depression

“…Although there is a great deal of evidence for the efficacy of both antidepressant medication and psychological interventions for depression (see Joffe, Sokolov, & Streiner, 1996 and Cuijpers, van Straten, Andersson, & van Oppen, 2008 for meta-analyses of the efficacy of antidepressant medication and psychotherapy for depression, respectively), concerns unique to the perinatal period may influence the efficacy of these treatments for this population (Kim, O'Reardon, & Epperson, 2010). For example, in an attempt to limit fetal exposure, antidepressants may be prescribed below therapeutic dosage levels (Bennett, Einarson, Taddio, Koren, & Einarson, 2004a). This problem is complicated further by the fact that most women actually require higher doses of antidepressant medication during pregnancy (Dawes & Chowienczyk, 2001; Hostetter, Stowe, Strader, McLaughlin, & Llewellyn, 2000; Wisner, Perel, & Wheeler, 1993).…”